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    Do you screen for BDD?

    Not only is body dysmorphic disorder (BDD) widespread among patients pursuing facial plastic surgery, but few surgeons are able to correctly identify BDD patients, according to a study recently published in JAMA Facial Plastic Surgery.

    The authors also note that patients who screen positive on the Body Dysmorphic Disorder Questionnaire (BDDQ) are less satisfied with their appearance at baseline.

    “Patients with BDD frequently seek facial cosmetic surgery,” says co-author Lisa Ishii, M.D., an associate professor of facial plastic and reconstructive surgery at Johns Hopkins School of Medicine. “We needed to know the prevalence in our patient population, and we needed an efficient way to screen for them.”

    The multicenter prospective study consisted of 597 patients who presented at academic and private facial plastic and oculoplastic surgery practices.

    All patients were screened for BDD using the BDDQ, after which surgeons independently evaluated the likelihood that a patient had BDD.

    Overall, 9.7% of patients screened positive for BDD. However, only 4.0% of patients were clinically suspected of having BDD by surgeons.

    Specifically, 13.1% of patients presenting for cosmetic surgery had a positive BDDQ screening, compared to only 6.7% of patients presenting for reconstructive surgery.

    Likewise, surgeons were only able to correctly identify 4.7% of patients overall who had a positive BDDQ screening, and the positive likelihood ratio was only 1.19.

    “We were somewhat surprised about just how common BDD is in our patient population,” Dr. Ishii tells The Aesthetic Channel. She was also surprised that surgeons were not very good at determining which patients had BDD after speaking with them.

    The authors believe that routine implementation of validated BDD screening instruments can improve patient care.

    “Patients suffering from BDD benefit from psychological therapy,” Dr. Ishii says. “Although BDD is not an absolute contraindication to cosmetic surgery, our patients will have better results when we are able to address their psychiatric needs first, followed by their physical needs, as appropriate. The goal is to provide our patients with the highest quality outcomes.”

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